The governance of primary mental health planning by Primary Health Networks

Abstract

The establishment of Primary Health Networks (PHNs) was accompanied by assignment of responsibility for funding for primary mental healthcare. To ensure this funding is spent in line with government priorities, the Federal government developed a planning document with established priorities and guidance documents for how the planning document should be completed. This paper examines how these documents shape service delivery through enabling some activities and excluding others and identifies the assumptions that underpin these documents. Data were drawn from discourse and content analysis of completed planning documents from the PHNs and of the guidance documents and from reflection upon mental health planning from 55 interviews with key personnel from six PHNs. Service delivery is shaped by outcome measures that promote service access, cost‐effectiveness and clinical effectiveness, contributing to service options that favour self‐management for mild mental illness and clinical (but not social) services for people with severe mental illness. There is also limited scope for mental health promotion with prevention activities focused upon populations identified by the government as being at‐risk. This occurs to the detriment of other at‐risk populations.

The moral and political economy of suicide prevention

“…In the absence of ethical concepts and frameworks in national suicide prevention policies and strategies, decisions about resource allocation are invariably influenced by judgements about cost-effectiveness and overall return on investment in terms of population health, rather than in reference to notions of equity, fairness, and social justice. The focus on resource allocation rather than on agreed health and social outcomes can result in inequitable and inefficient distributional decisions that favour some service options and at-risk populations over others (Henderson et al, 2019; Rosenberg et al, 2009). As a funder rather than a provider of suicide prevention services, political accountability focuses predominantly on the deployment of public resources, with little emphasis given to quality improvements in governance, management, and services (Rosenberg and Salvador-Carulla, 2017).…”